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TMSIS Dataguide Medicaid.gov
Version 3.36.0

RULE-7930

Data Quality Measure
Last updated

Key Information

Measure Name % of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
File Type CLT
Measure ID RULE-7930
Measure Type Claims Percentage
Content area ALL MULTI PRO

Validation

Validation Type Inferential

Measure Priority

Measure Priority High
Focus Area N/A
Category Provider enrollment

Claim Information

Claim Type Medicaid,FFS or CHIP,FFS
Adjustment Type Original and Replacement
Crossover Type All Indicators

Thresholds

Minimum 0
Maximum 0.02
TA Minimun 0
TA Maximum 0.02
Longitudinal Threshold N/A
For TA
(for including in compliance training) 		TA- Inferential
For TA
(Longitudinal) 		No

Data Elements

DD Data Element BEGINNING-DATE-OF-SERVICE • PROV-IDENTIFIER • ENDING-DATE-OF-SERVICE • BILLING-PROV-NUM • SUBMITTING-STATE-PROV-ID
DD Data Element Number COT033 • PRV081 • COT034 • COT112 • PRV019

Annotation N/A
Specification RULE-7930